Category: Anxiety

Training basic surgical techniques on toy animals before having to perform operations on living animals makes veterinary students much less anxious. At the same time, the use of laboratory animals is minimised. This is documented by a new PhD thesis from LIFE — the Faculty of Life Sciences at the University of Copenhagen.

A surgical skills laboratory, also known as the 'teddy laboratory', strengthens learning and the teaching environment.

The laboratory allows students to train basic surgical skills on toy animals designed to resemble and feel like real animals featuring, for example, organs, veins and arteries.

"In comparison with performing surgical procedures on dead animals or laboratory animals, we can see that the students feel more confident learning the basic surgical techniques using toy animals. Anxiety hampers learning so it is hardly surprising that the greater sense of confidence among students has resulted in them having a much easier time learning and remembering the surgical techniques," says Rikke Langebæk, PhD and senior veterinary surgeon, who has developed the skills laboratory. She adds:

"Also, we want to do everything in our power to reduce the use of laboratory animals for teaching purposes."

Less fear and improved learning

Measurements of students' heart rate, questionnaires and interviews show that after attending the 'teddy laboratory', students are considerably less fearful and better prepared for performing surgery on living animals.

Rikke Langebæk's interviews of students have identified four aspects of the models which are important: The visual, the dimensional, the tactile and the situational aspect. On a four-point so-called Likert scale (poor/reasonable/good/really good), 75% of students rated the toy animal models as being 'good' or 'really good' for learning surgical procedures.

The skills laboratory opened in 2007, whereas previously the only chance veterinary students had of training simple surgical techniques was using dead animals which had been donated for teaching purposes.

Experience shows that such training is not sufficient to alleviate the students' anxiety and sense of insecurity when subsequently having to operate on living animals.

 Exposure to television coverage of terrorism causes women to lose psychological resources much more than men, which leads to negative feelings and moodiness. This has been shown in a new study, conducted at the University of Haifa and soon to be published in Anxiety, Stress & Coping, that examined the differences between men and women in a controlled experiment environment.

An earlier study conducted by Prof. Moshe Zeidner of the Department of Counseling and Human Development at the University of Haifa and Prof. Hasida Ben-Zur of the University of Haifa's School of Social Work, has shown that viewing television coverage of terrorism causes viewers to lose psychological resources, such the sense of significance or success, and causes a feeling of being threatened. The current study set out to examine whether there are differences between men and women in the levels of psychological resource loss.

According to the authors of the new study, earlier research dealing with gender differences in the effects of traumatic events examined data based on questionnaires relating to past experiences. The present study is now taking a new step as it is examining these differences in a controlled experiment environment in which all of the participants are exposed to the same events and report on their feelings immediately following the events.

In order to create such a controlled environment, men and women were shown news video clips reporting on terrorist attacks that took place over the past few years and which resulted in serious casualties. In parallel, two other groups of men and women were shown news coverage of "regular," everyday news events.

The results of this study show that the women who viewed terrorism coverage testified to higher levels of feeling threatened and lower levels of psychological resources compared to the men who viewed the same news reports. These gender differences were not found amongst the control groups. The study has also found that the feeling of being threatened and loss of resources has an effect on the senses and lead to a higher level of negativity, such as hostility and moodiness.

"It is possible that the differences between men and women are founded in gender socialization, 'teaching' women to respond to terrorism with more anxiety than men," said Prof. Moshe Zeidner.

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Journal Reference:

1. Hasida Ben-Zur, Moshe Zeidner. Gender differences in loss of psychological resources following experimentally-induced vicarious stress. Anxiety, Stress & Coping, 2011; DOI: 10.1080/10615806.2011.619526

Rats exposed to stress during early development inherit the effects of that stress to their offspring, largely expressed in behavior impairments but also characteristics of resilience, shows a new study from the University of Haifa, published in the journal Developmental Psychobiology.

Providing environmental enrichment to the future mother rats had a remedial role on some of the negative effects. "The similarities between rats and humans raise the question of whether similar effects might transpire in humans; for example, exposure to war or natural disasters might have heritable effects," explains Prof. Micah Leshem who headed the study.

The study, conducted by Prof. Leshem of the Department of Psychology at the University of Haifa along with Prof. Jay Schulkin of Georgetown University and postgraduate students Hiba Zaidan and Neta Kvetniy-Ferdman, set out to examine the cross-generational effects of early exposure to stress and enrichment. The researchers examined rats because of their resemblance to humans and their rapid rate of development and reproduction, which facilitates cross-generational studies.

The researchers studied 40 female rats weaned at 27 days of age. One group of these females — the control group — was then raised normally in individual cages; the second group was exposed to different stressors; the third was enriched; and the fourth group was both stressed and enriched. The matured rats were mated at 60 days, had normal pregnancies and births, and their offspring pups were divided into two groups — one raised normally, and the other raised in an enriched environment, so that the effect of "therapy" on the next generation could also be evaluated. The offspring groups were then evaluated with respect to social interaction, anxiety levels, ability to learn and capacity to cope with fear.

The study's main findings showed that the early treatment of the mothers impacted their offspring behavior. Stress to the mothers reduced social interaction in their offspring, but improved their ability to learn to avoid distress. Male offspring were also better at coping with fear. Some of these changes were mitigated by enrichment to the mothers, so that stressing the mothers and then providing them with a "therapeutic" (enriched) environment, prevented some, but not all, of the effects in the next generation. Providing enrichment to the offspring also offset some of the inherited effects.

According to the researchers, their study, with other evidence, "suggests that evolution equipped the parent generation to sample its environment, and then, possibly via heritable epigenetic changes, to prepare the next generation to better cope with this environment," Prof. Leshem explains. "It is important to investigate whether stressful experiences at a young age affect the next generation, and whether therapeutic experiences can minimize the trans-generational effects in humans too. As our study shows that the inheritance of the effects of adversity can be modified by timely intervention, this may have important educational and therapeutic implications," he concludes.

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Journal Reference:

1. Micah Leshem, Jay Schulkin. Transgenerational effects of infantile adversity and enrichment in male and female rats. Developmental Psychobiology, 2011; DOI: 10.1002/dev.20592

Cancer patients may benefit from sessions with trained music therapists or from listening to music. A new Cochrane systematic review shows using music can reduce anxiety in cancer patients, and may also have positive effects on mood, pain and quality of life.

Music and music therapy are used in a wide range of clinical settings. Treatments range from patients listening to pre-recorded music, to music therapists engaging patients in music experiences to improve psychological and physical well-being. In the review, researchers focused on trials with patients with any kind of cancer who were offered music or music therapy sessions.

The researchers analysed evidence from 1,891 patients taking part in 30 trials. 13 trials used trained music therapists, while in the remaining 17 trials, patients listened to pre-recorded music. How long and how often patients participated in music sessions varied greatly among trials. The results show that compared to standard treatments, music reduced anxiety considerably based on clinical anxiety scores. Some trials reported much larger beneficial effects than others. The results also suggest that music therapy may increase patients' quality of life. There was some benefit in music for mood and pain, although not depression. Smaller beneficial effects were seen for heart rate, respiratory rate and blood pressure.

"The evidence suggests that music interventions may be useful as a complementary treatment to people with cancer," said lead researcher Joke Bradt of the Department of Creative Arts Therapies at Drexel University in Philadelphia, US. "Music interventions provided by trained music therapists as well as listening to pre-recorded music both have shown positive outcomes in this review, but at this time there is not enough evidence to determine if one intervention is more effective than the other."

"It should be noted, however, that when patients can't be blinded to an intervention, there is an opportunity for bias when they are asked to report on subjective measures like anxiety, pain mood and quality of life," said Bradt.

The researchers point out that the quality of evidence for some outcomes was low because of the small numbers of trials that have been carried out. Further trials could help increase certainty in the findings and improve understanding of music's impact on distress, body image and other aspects, for which research is currently too scarce to draw any conclusions.

Knowing the right way to handle stress in the classroom and on the sports field can make the difference between success and failure for the millions of students going back to school this fall, new University of Chicago research shows.

"We found that cortisol, a hormone released in response to stress, can either be tied to a student's poor performance on a math test or contribute to success, depending on the frame of mind of the student going into the test," said Sian Beilock, associate professor in psychology at UChicago and one of the nation's leading experts on poor performance by otherwise talented people.

She is the author of "Choke: What the Secrets of the Brain Reveal About Getting it Right When You Have To," released this month in paperback.

In a new paper published in the current issue of the journal "Emotion," Beilock and her colleagues explore the topic of performance failure in math and show, for the first time, that there is a critical connection between working memory, math anxiety and salivary cortisol.

Working memory is the mental reserve that people use to process information and figure out solutions during tests. Math anxiety is fear or apprehension when just thinking about taking a math test. Cortisol is a hormone produced by the adrenal gland and associated with stress-related changes in the body; it is often referred to as the "stress hormone."

Tracking math anxiety in students

Beilock and her team tested 73 undergraduate students to determine their working memory capacities and their level of math anxiety. They also measured cortisol levels (via a saliva sample) before and after a stressful math test. They published the results in a paper titled "Choke or Thrive? The Relation between Salivary Cortisol and Math Performance Depends on Individual Differences in Working Memory and Math Anxiety."

Among students with low working memories, there was little difference in performance related to either cortisol production or math anxiety, the study found. Students with lower working memory exert relatively less mental effort to begin with, researchers found, so taking a stressful test didn't drastically compromise their performance.

Among people with large working memories, those who were typically the most talented, rising cortisol either led to a performance boost or a performance flop — depending on whether they were already anxious about math. For students without a fear of math, the more their cortisol increased during the test, the better they performed — for these confident students, the body's response to stress actually pushed them to greater heights. In contrast, for students with more anxiety about math, surging cortisol was tied to poor performance.

"Under stress, we have a variety of bodily reactions; how we interpret these reactions predicts whether we will choke or thrive under pressure," Beilock said. "If a student interprets their physiological response as a sign they are about to fail, they will. And, when taking a math test, students anxious about math are likely to do this. But the same physiological response can also be linked to success if a student's outlook is positive," she further explained.

In other words, a student's perspective can determine success or failure. Students can change their outlooks by writing about their anxieties before a test and "off-loading" their fears, or simply thinking about a time in the past when they have succeeded, her research has shown.

Taking an exam brings on a different kind of pressure than when a student recites a memorized speech before classmates or an athlete plays before a packed stadium, other research by Beilock and her team demonstrates.

Why people choke under pressure

In another paper published this month in the Journal of Experimental Psychology, Beilock and her colleagues identify, for the first time, different ways in which people can fumble under pressure. They also suggest remedies. The work, which was based on a series of experiments with several hundred undergraduate students in varying stressful situations, is reported in the paper "Choking Under Pressure: Multiple Routes to Skill Failure."

The experiments explored two theories of why people choke: One holds that people are distracted by worries, and as a result, fail to access their talents; another conversely proposes that stress causes people to pay too much attention to their performance and become self-conscious.

"What we showed in these experiments is that the situation determines what kind of choking develops. Knowing this can help people choose the right strategy to overcome the problem," Beilock said.

In the case of test-taking, good test preparation and a writing exercise can boost performance by reducing anxiety and freeing up working memory. The kind of choking prompted by performing before others calls for a different remedy.

"When you're worried about doing well in a game, or giving a memorized speech in front of others, the best thing to do is to distract yourself with a little tune before you start so you don't become focused on all the details of what you've done so many times before," she said. "On the playing field, thinking too much can be a bad thing," she further explained.

The work in the two papers, as well as research for the Choke, was supported with grants from the National Science Foundation. Co-authors for "Choking Under Pressure" were Marci DeCaro of Vanderbilt University, and Robin Thomas of Miami University and Neil Albert of UChicago. Joining Beilock in writing "Choke or Thrive?" were Andrew Mattarella-Micke, Jill Mateo and Katherine Foster of UChicago, and Megan Kozak of Pace University.

People who are cyberstalked or harassed online experience higher levels of stress and trauma than people who are stalked or harassed in person, according to a presentation at the American Psychological Association's 119th Annual Convention.

"Increasingly, stalkers use modern technology to monitor and torment their victims, and one in four victims report some form of cyberstalking, such as threatening emails or instant messaging," said Elizabeth Carll, PhD, in a talk entitled, "Electronic Harassment and Cyberstalking: Intervention, Prevention and Public Policy."

Emotional responses to the stress and trauma experienced by victims may include high levels of ongoing stress, anxiety, fear, nightmares, shock and disbelief, helplessness, hyper-vigilance, changes in eating, and sleeping difficulties, Carll said.

"It is my observation that the symptoms related to cyberstalking and e-harassment may be more intense than in-person harassment, as the impact is more devastating due to the 24/7 nature of online communication, inability to escape to a safe place, and global access of the information," Carll said.

U.S. Department of Justice statistics reveal that some 850,000 adults, the majority female, are targets of cyberstalking each year, according to Carll. Citing various other sources, she gave examples of the pervasiveness, including:

• 40 percent of women have experienced dating violence via social media, which can include harassing text messages and disturbing information about them posted on social media sites.
• 20 percent of online stalkers use social networking to stalk their victims.
• 34 percent of female college students and 14 percent of male students have broken into a romantic partner's email.

"The same technologies used to harass can also be used to intervene and prevent harassment," she said, adding that some states are considering mandating the use of GPS tracking devices on offenders to allow victims to keep tabs on them.

"Imagine a cell phone application that can tell you if someone threatening you is nearby," Carll said. "That could be life-saving."

Law enforcement, legal assistance and other social service providers need training to use direct and electronic methods to intervene and prevent electronic harassment, and victims need training in the safe use of technology, she said.

In another session August 5, researchers released results of a study that found 36 percent of students had been cyberbullied at least once in the past year.

Researchers examined data collected in 2009 from 1,112 students, ages 12 to 19, 405 female, from schools in Seoul and the Keonggi area of South Korea. Of these, 225 were in elementary school, 678 in middle school and 209 in high school. The students completed a questionnaire about their cyberbullying experiences, self-esteem and how they regulate their emotions.

"The results revealed that cyberbullying makes students socially anxious, lonely, frustrated, sad and helpless," said presenter YeoJu Chung, PhD, of South Korea's Kyungil University.

The research explored how adolescents emotionally deal with cyberbullying. Students who said they ruminated, or obsessed, about the negative event were more likely to suffer serious stress from cyberbullying. In addition, people who blamed themselves for the situation were more likely to ruminate. Students who refocused on positive thoughts were able to cope and recover more quickly, according to the study.

Students reported that they were more negatively affected by cyberbullying when it was anonymous and in "one-sided sites such as blogs and cyber boards." The research also showed that students who are victims of cyberbullying will often subsequently bully others online.

"Lots of adolescents have trouble recovering from negative effects of cyberbullying," said Chung. "We can help them use emotion regulation skills to recover, rather than become bullies themselves."

A new study gauging the impact of consuming more fish oil showed a marked reduction both in inflammation and, surprisingly, in anxiety among a cohort of healthy young people.

The findings suggest that if young participants can get such improvements from specific dietary supplements, then the elderly and people at high risk for certain diseases might benefit even more.

The findings by a team of researchers at Ohio State University were just published in the journal Brain, Behavior and Immunity. It is the latest from more than three decades of research into links between psychological stress and immunity.

Omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have long been considered as positive additives to the diet. Earlier research suggested that the compounds might play a role in reducing the level of cytokines in the body, compounds that promote inflammation, and perhaps even reduce depression.

Psychological stress has repeatedly been shown to increase cytokine production so the researchers wondered if increasing omega-3 might mitigate that process, reducing inflammation.

To test their theory, they turned to a familiar group of research subjects — medical students. Some of the earliest work these scientists did showed that stress from important medical school tests lowered students' immune status.

"We hypothesized that giving some students omega-3 supplements would decrease their production of proinflammatory cytokines, compared to other students who only received a placebo," explained Janice Kiecolt-Glaser, professor of psychology and psychiatry.

"We thought the omega-3 would reduce the stress-induced increase in cytokines that normally arose from nervousness over the tests."

The team assembled a field of 68 first- and second-year medical students who volunteered for the clinical trial. The students were randomly divided into six groups, all of which were interviewed six times during the study. At each visit, blood samples were drawn from the students who also completed a battery of psychological surveys intended to gauge their levels of stress, anxiety or depression. The students also completed questionnaires about their diets during the previous weeks.

Half the students received omega-3 supplements while the other half were given placebo pills.

"The supplement was probably about four or five times the amount of fish oil you'd get from a daily serving of salmon, for example," explained Martha Belury, professor of human nutrition and co-author in the study.

Part of the study, however, didn't go according to plans.

Changes in the medical curriculum and the distribution of major tests throughout the year, rather than during a tense three-day period as was done in the past, removed much of the stress that medical students had shown in past studies.

"These students were not anxious. They weren't really stressed. They were actually sleeping well throughout this period, so we didn't get the stress effect we had expected," Kiecolt-Glaser said.

But the psychological surveys clearly showed an important change in anxiety among the students: Those receiving the omega-3 showed a 20 percent reduction in anxiety compared to the placebo group.

An analysis of the of the blood samples from the medical students showed similar important results.

"We took measurements of the cytokines in the blood serum, as well as measured the productivity of cells that produced two important cytokines, interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFa)," said Ron Glaser, professor of molecular virology, immunology & medical genetics and director of the Institute for Behavioral Medicine Research.

"We saw a 14 percent reduction in the amounts of IL-6 among the students receiving the omega-3." Since the cytokines foster inflammation, "anything we can do to reduce cytokines is a big plus in dealing with the overall health of people at risk for many diseases," he said.

While inflammation is a natural immune response that helps the body heal, it also can play a harmful role in a host of diseases ranging from arthritis to heart disease to cancer.

While the study showed the positive impact omega-3 supplements can play in reducing both anxiety and inflammation, the researchers aren't willing to recommend that the public start adding them to the daily diet.

"It may be too early to recommend a broad use of omega-3 supplements throughout the public, especially considering the cost and the limited supplies of fish needed to supply the oil," Belury said. "People should just consider increasing their omega-3 through their diet."

Some of the researchers, however, acknowledged that they take omega-3 supplements.

Also working on the research with Kiecolt-Glaser, Glaser and Belury were William Malarkey, professor emeritus of internal medicine, and Rebecca Andridge, an assistant professor of public health.

The study was supported in part by a grant from the National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health.

Training teenagers to look at social situations positively could help those with anxiety and may help prevent problems persisting into adult life, new research from Oxford University is beginning to suggest.

The researchers found that tasks designed to prompt either positive or negative interpretations of unclear situations can shift how healthy teenagers think about such events. The approach is called 'cognitive bias modification of interpretations' or CBM-I.

Having shown in the lab that positive or negative styles of thinking can be induced in adolescents without any anxiety problems, the team now wants to see if it is possible to change the negative thoughts that can drive problems in teenagers with high anxiety.

The researchers from Oxford University, along with a colleague at the Institute of Psychiatry, have published their findings in the Springer journal Child Psychiatry and Human Development.

"It's thought that some people may tend to draw negative interpretations of ambiguous situations," explains Dr Jennifer Lau who led the work at the Department of Experimental Psychology at Oxford University.

"For example, I might wave at someone I recently met on the other side of the street. If they don't wave back, I might think they didn't remember me — or alternatively, I might think they're snubbing me.

"People with anxiety are more likely to assume the latter interpretation. These negative thoughts are believed to drive and maintain their feelings of low mood and anxiety. If you can change that negative style of thinking, perhaps you can change mood in anxious teenagers."

Adolescence appears to be a general period of vulnerability when problems with anxiety and depression can first emerge, and new treatments are needed. Cognitive behaviour therapy, for example, doesn't work for everyone and it may not be available everywhere.

Estimates vary about prevalence of anxiety among teenagers, but it could be around 10-15%. The teenage years are a period when biological changes coincide with the development of areas of the brain involved in emotional control and with big social changes, such as changing schools and friendship groups, and first romantic interests. Yet despite this, anxiety and depression in adolescents has remained a rather neglected area of study compared with adults.

"Of course it's normal for teenagers to be worried about exams, friends, social acceptance, and about the future generally," says Dr Lau. "But anxiety can become a problem when it becomes persistent or is out of proportion to the situation. For example when someone is doing well at school but still worries all the time and can't control the worry. In some extreme cases kids avoid going to school because they are anxious. This is not being just a little bit worried."

Dr Lau and colleagues set out to assess whether simple training tasks carried out at a computer screen can change the reactions teenagers have to imagined social situations, leading them to take either more positive interpretations of the situations or more negative.

Thirty-six healthy teenagers from schools in Oxfordshire and Buckinghamshire took part in the study, and were randomly allocated to receive training designed to boost positive readings of scenarios or negative readings.

The training consisted of working through a set of short scenarios involving social situations that are familiar — such as reading a comment about your photo on Facebook — but ambiguous in how you might respond to them emotionally.

The volunteers then had to complete these ambiguous stories, being prompted to give answers which tended to resolve the situation in either a positive way or a negative way — depending on what type of training they were allocated to in the study.

Following this period of training, the researchers assessed if there was any difference in how likely participants were to rate further scenarios as positive or negative. Volunteers' mood was also assessed throughout the study.

The researchers found that the training task was able to induce different interpretation biases in the teenagers. Those who received positive training tended to endorse positive readings of the ambiguous scenarios, while those who received the negative training were more likely to view the scenarios more negatively. It suggests that the approach is able to shift teenager's interpretations of situations, at least in this laboratory setting.

Dr Lau says: "Although these results are early, and among a limited number of healthy teenagers, we hope this approach to encourage positive interpretations of events will prove to be a powerful tool. If we are able to intervene early and effectively in teenagers with anxiety, we may be able to prevent later adult problems.

"The next steps are to give people with high levels of anxiety these training tasks to see if it helps change their mood over significant periods of time."

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Journal Reference:

1. Jennifer Y. F. Lau, Emma Molyneaux, Machteld D. Telman, Stefano Belli. The Plasticity of Adolescent Cognitions: Data from a Novel Cognitive Bias Modification Training Task. Child Psychiatry & Human Development, 2011; DOI: 10.1007/s10578-011-0244-3

— A big part of coping with life is having a flexible reaction to the ups and downs. Now, a study which will be published in an upcoming issue of Psychological Science, a journal of the Association for Psychological Science, finds that people choose to respond differently depending on how intense an emotion is. When confronted with high-intensity negative emotions, they tend to choose to turn their attention away, but with something lower-intensity, they tend to think it over and neutralize the feeling that way.

Emotions are useful — for example, fear tells your body to get ready to escape or fight in a dangerous situation. But emotions can also become problematic — for example, for people with depression who can't stop thinking about negative thoughts, says Gal Sheppes of Stanford University, who cowrote the study with Stanford colleagues Gaurav Suri and James J. Gross, and Susanne Scheibe of the University of Groningen. "Luckily, our emotions can be adjusted in various ways," he says.

Sheppes and his colleagues studied two main ways that people modulate their emotions; by distracting themselves or by reappraising the situation. For example, if you're in the waiting room at the dentist, you might distract yourself from the upcoming unpleasantness by reading about celebrity breakups — "Maybe that's why the magazines are there in the first place," Sheppes says — or you might talk yourself through it: "I say, OK, I have to undergo this root canal, but it will make my health better, and it will pass, and I've done worse things, and I can remind myself that I'm OK."

While many previous studies directly instructed people to employ different strategies and measured their consequences, the researchers wanted to know which regulation strategies people choose for themselves when confronted with negative situations of mild and strong intensity. In one experiment, participants chose how to regulate negative emotions induced by pictures that produce a low-intensity emotion and some that produce high-intensity emotion — a picture of a snake in the grass, for example, should give you low-intensity fear, while a picture of a snake attacking with an open mouth should be more intense. In another experiment, participants chose how to regulate their anxiety while anticipating unpredictable electric shocks, but they were told before each shock whether it would be of low intensity or more painful shock. Before the experiments, the participants were trained on the two strategies, distraction and reappraisal, and during the experiments, they talked about which strategy they were using at which time.

In both experiments, when the negative emotion was low-intensity, participants preferred to reappraise — think through it, telling themselves why it wasn't so bad. But when high-intensity emotions arose, they preferred to distract themselves.

It's helpful to understand which strategies healthy people choose to regulate their emotions in different contexts, Sheppes says, because it seems like people with depression and anxiety disorders might have those problems partially because it is hard for them to flexibly modulate their emotions to differing situational demands. "Maybe they need to learn when and when not to engage," he says.

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Journal Reference:

1. Gal Sheppes, Gaurav Suri, James J. Gross, and Susanne Scheibe. Emotion Regulation Choice. Pyschological Science, 2011